Many Patients Fail to Take Drugs After Heart Attack

MONDAY, Feb. 25 -- A quarter of the people who survive heart attacks don't take the drugs prescribed for them after they leave the hospital, a new study finds.

That failure to adhere to medication increases the patient's risk of dying in the next year, Canadian researchers say.

"About one in five of all prescriptions weren't filled after the patients left the hospital," noted study lead author Cynthia A. Jackevicius, a pharmacist at the Institute for Clinical Evaluative Sciences in Toronto. Her team published its findings in the Feb. 26 issue of Circulation.

Patients who filled none of their prescriptions had an 80 percent higher risk of dying in the year after a heart attack compared to those who filled all of them, Jackevicius said. And even for those who filled some, but not all, of their prescriptions, the one-year death risk was 44 percent higher than for those who adhered to all their medications, the team found.

The study looked at the records of almost 4,600 residents of the province of Ontario aged 65 or older who had experienced heart attacks. In total, they took almost 13,000 prescriptions home with them upon discharge from the hospital.

Twenty-seven percent of those prescriptions had still not been filled seven days after hospital discharge, and 21 percent were still open 120 days later, the study found.

People were much more likely to fill prescription for heart-related drugs such as beta blockers, ACE inhibitors and statins, the study found, compared to other types of drugs. In general more than 80 percent of those prescriptions were filled. But at best, only a third of non-cardiac drug prescriptions were filled.

Cost of the medications was not a major issue in this study, Jackevicius said, since those in the study were covered by a health program sponsored by the province. "The population we looked at had a very small co-pay and good coverage," she said. "If they were elderly and low income, they paid $2 a prescription, so that was not much of a deterrent. Those with higher incomes pay $6 per prescription."

What did matter was the information people got before they left the hospital, Jackevicius said. "Those who were educated in the hospital were more likely to fill their prescriptions," she noted.

The economic situation is different in the United States, where at least one study has shown that use of medications is affected by cost, but "I think this [study] can be extrapolated to the United States," said Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York.

"The most important point is that patients who are educated, patients who understand why taking medications is important, are people who are more likely to be taking them," Steinbaum said.

Doctors and hospitals must make an extra effort to inform these people of the value of the drugs they are prescribed, she said. "During the time after something as dramatic as a heart attack, they very often won't remember or are too scared to ask questions," Steinbaum noted. "It calls for a team approach. As physicians, we explain something to a patient, but that's why you have nurses, that's why you have pharmacists."

Her practice is to check on people after they go home, she said. "It's nice to see them after a few weeks and ask if they are taking their medicine," Steinbaum said. "What is amazing is that we know how significant the benefits are of taking these medications. Compliance is always an issue, but people who understand why they are taking a medication, what the side effects are, are more likely to be in compliance."

Further studies are needed to learn more about why people don't take prescribed medicines, Jackevicius said. "But educating patients, putting a greater emphasis on that, would be something that is important," she said.